Figure 1. The five specific concepts that help create the state of mindfulness that is needed for reliability, which in turn is a prerequisite for safety
Becoming a High Reliability Organization: Operational Advice for Hospi
A flowchart with 4 columns. The first column is titled: Specific Considerations. Five concepts are listed in the column: sensitivity to operations; preoccupation with failure; deference to expertise; resilience; and reluctance to simplify. The concepts flow into the second column, titled: General Orientation. There is a sunburst in the center of the column, with the words: State of Mindfulness. This flows into the third column, titled: Impact on Processes. There is a checkmark in the center of the column, with the words, High Reliability. This flows into the fourth column, titled: Ultimate Outcome. In the center are the words, Exceptionally Safe, Consistently High Quality Care.
Figure 2. Sensitivity to operations
A drawing of a man in a hospital bed surrounded by three staff members. The following objects in the room are circled: the face of one doctor, the folder in a doctor's hand, a clipboard, a cabinet, a monitor, pills and glass of water on a table, an infusion bag, a clock face, the identification tag on the patient's wrist.
Sensitivity to operations encompasses more than checks of patient identity, vital signs, and medications. It includes awareness by staff, supervisors, and management of broader issues that can affect patient care, ranging from how long a person has been on duty, to the availability of needed supplies, to potential distractions.
Figure 3. Reluctance to simplify
A drawing of a humorous production line. A gloved hand is pushing a squirrel holding a nut. There are many levers, pulleys, weights, hammers, and balls. The goal of the production line is not clear.
Oversimplifying explanations for how things work risks developing unworkable solutions and failing to understand all the ways in which a system may fail, placing a patient at risk.
Figure 4. Preoccupation with failure
A drawing of a car that has run off the road and is on the edge of a cliff. One passenger is thinking, "Wow that was close! Glad we had good brakes!"
The other passenger is thinking, "Wow that was close! We almost died!"
A preoccupation with failure means that near misses are viewed as invitations to improve rather than as proof that a system has enough checks to prevent a catastrophic failure.
Figure 5. Deference to expertise
A drawing of a woman in a hospital bed surrounded by three staff members and a family member. The nurse is thinking, "She's getting weaker."
The doctor is thinking, "Several complications could explain this."
The pharmacist is thinking, "Some meds could be interacting."
The husband is thinking, "She's upset about going to a nursing home."
In many situations, different staff members as well as the patient and family may have information essential to providing ideal care. Deference to expertise entails recognizing the knowledge available form each person and deferring to whoever's expertise is most relevant to the choices being made.
Figure 6. Resilience
A drawing of a man in a small motor boat. The man is wearing a life jacket and the boat is equipped with a life buoy, fire extinguisher, oars, and a pump.
A good boater never leaves the dock without preparing for many situations that are unlikely but possible. Oars, pump, lifejacket, and fire extinguisher ensure that the boater can quickly respond to unexpected system failures.